Healthcare Provider Details

I. General information

NPI: 1245502889
Provider Name (Legal Business Name): MR. TAIWO OLUMIDE OLUYEMO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2012
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 ORCHARD ORIOLE WAY
ODENTON MD
21113-6038
US

IV. Provider business mailing address

2720 ORCHARD ORIOLE WAY
ODENTON MD
21113-6038
US

V. Phone/Fax

Practice location:
  • Phone: 301-326-5867
  • Fax: 202-609-7409
Mailing address:
  • Phone: 301-326-5867
  • Fax: 202-609-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1009677
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1009677
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR181061
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR181061
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: